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The only time payment in advance is unnecessary as a result of the Certificate of Application of Health Insurance Limit Amount is in the case of legally paid high medical care costs. For Accenture Health Insurance Society, the amount you are ultimately required to pay is around 20,000 yen due to additional benefits, but the amount paid as additional benefits must be paid by you in advance at the medical care institution.
Regarding high medical care costs, the limit on the amount that you are required to pay is approximately 60,000 yen if your standard monthly remuneration is 260,000 yen or less, approximately 80,000 yen if your standard monthly remuneration is 280,000 yen or more, approximately 170,000 yen if your standard monthly remuneration is 530,000 yen or more, or approximately 250,000 yen if your standard monthly remuneration is 830,000 yen or more. Note that, even if the final amount ends up being 20,000 yen, you will still have to pay the difference at the medical care institution.